9 Audit of morphine administration by east midlands ambulance service (EMAS)

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S Winter,

R Jootun

East Midlands Ambulance Service

Abstract

Aim For pre-hospital administration of morphine, JRCALC guidelines recommend recorded pain scores (PS) out of ten before and after use, an anti-emetic adjunct and ENTONOX provision prior to analgesic effect. This audit aimed to gain insight into how rigorously these guidelines were being adhered to in practice

Methods This clinical audit examined patients who had been administered morphine by EMAS staff. Inclusion criteria were patients who had received documented oral, intravenous or intramuscular morphine within a three-month period. Those who declined morphine were excluded. Data extracted from the patient report forms included: patient demographics; documented PSs; morphine doses and routes; adjunct analgesics and use of anti-emetics. This information was used to determine how appropriately PSs, analgesic adjuncts and anti-emetics were being used alongside morphine.

Results There were 293 patients included in the audit. 205 (70.0%) had a PS documented before and after morphine administration; 50 (17.1%) had one documented PS and 38 (13.0%) had none. 58 (19.8%) patients received ENTONOX before the administration of morphine and 17 (5.8%) received it after morphine. 218 (74.4%) had no record of ENTONOX administration and only 100 (34.1%) patients were prescribed an anti-emetic with morphine.

Conclusion There is potential for improved adherence to JRCALC guidelines through increased awareness and education. We will trial this at EMAS through staff notices followed by a re-audit in 4–6 months. Ideally, audits within other ambulance services with more patients would be undertaken for widespread quality improvement.

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